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By Birgit Wolz, Ph.D., and Ofer Zur, Ph.D.
Table Of Contents
(For detailed descriptions of the movies, click here)
Antwone Fisher
Dressed To Kill
Frances
Girl, Interrupted
Good Will Hunting
Gross Point Blank
Antwone Fisher
Antwone Fisher, an African-American in the U.S. Navy, has trouble with his anger. An African-American psychiatrist, Dr. Jerome Davenport, helps him work through his extensive childhood trauma.
The first sessions are largely characterized by Fisher’s squirming in silence. In order to give Antwone the time necessary to open up and to let him carry the responsibility for treatment success, the psychiatrist states that their three sessions do not start until Fisher begins talking. Toward the end of the fifth session, Antwone starts sharing his story, and the emotional floodgates open. At this point, the psychiatrist starts therapy by utilizing gentle but probing questioning.
Several times the psychiatrist addresses Antwone as “son.” When he encourages him to locate his family, he even says “I love you, son.”
This use of language could demonstrate that Davenport evolves temporarily into a father figure for a man robbed of guidance and in need of re-parenting. Antwone becomes a surrogate son to the psychiatrist, who is himself in denial about the pain of his childless marriage. Like any intervention, the use of language must be in consideration of the context of therapy, which includes cultural, class, age, and relationships issues. What may be highly appropriate and clinically helpful may be highly inappropriate and unethical in different situations.
Dressed To Kill
After Kate Miller is brutally murdered, Dr. Elliot, her psychiatrist, and Detective Marino try to find her killer. Kate’s teenage son teams up with a prostitute, Liz Blake, who witnessed the murder, to do an investigation of their own.
As they discuss Kate’s mother, Elliott asks, “What are our options?” Using the word “our,” he implies that they are a team, making a joint decision, and that he is part of her family life.
The psychiatrist tells Kate in a directive way that she should not snap at him and says, “Think where your anger is going.”
If these were planned interventions, possibly to establish a therapeutic alliance, they might be ethical and therapeutically valuable; otherwise this use of language might interfere with a positive therapeutic outcome.
Frances
The actress Frances Farmer was a rebel since her teenage years. To gain control over her life, Frances’s mother, Lilian Farmer, orchestrates a series of hospitalizations. After an evaluation by a psychiatrist, Dr. Symington, Frances undergoes shock treatment and a lobotomy.
During their first meeting, Dr. Symington patronizes and de-humanizes Frances by making comments about the stresses faced by celebrities, by calling her “a fascinating case,” and telling his patient that he looks forward to solving her predicament. He also pigeon-holes Frances by stating that “creative people act erratically.”
He also makes a joke that shows his need to be appreciated for his cleverness.
There is no indication that this use of language is therapeutically valuable; it might therefore interfere with a positive therapeutic outcome.
Girl, Interrupted
After a half-hearted suicide attempt and being evaluated by psychiatrist Dr. Crumble, Susanna Kaysen spends one year at Claymoore. In this psychiatric hospital, she receives treatment from Dr. Melvin Protts and Dr. Sonia Wick, while nurse Valerie looks after her. Susanna befriends the other patients, Lisa, Daisy, Janet, and Georgina.
Because Susanna believes that she has no bones in her hand, Dr. Crumble asks her, for his evaluation, “If you had no bones in your hand, how did you pick up the Aspirin?” At the same time Susanna watches her mother taking a suitcase out of her car and asks, “What is my mother doing?” Crumble gets irritated and commands, “Would you answer my question please? How did you pick up the Aspirin, if you had no bones in your hand?” Susanna looks back at him with a helpless and sad expression saying, “By then they’d come back.” Crumble inquires impatiently about his patient’s drug habits. After she denies having used any illegal drugs, he says, “You need to go somewhere where you can get a genuine rest. And you are very lucky. The best place in the world for someone like you is less than half an hour from here.”
Because Crumble feels impatient, he uses inappropriate language. Sometimes strong language can be helpful if it is meant to convey to the client the therapist’s frustration. However, if it is done to retaliate or without awareness it can be clinically inappropriate and in extreme cases unethical.
Susanna stays in bed because she is depressed when her friend, Lisa, is taken to another ward. Nurse Valerie picks her up and throws her into a bathtub with cold water. She even pushes the patient’s head under the water when Susanna yells, “fuck!” Valerie says, “Sorry, too cold?” After an angry exchange, Valerie says, “You are a lazy, self-indulgent little girl who is driving herself crazy.”
Because Valerie is angry, she behaves inappropriately even though she seems to have Susanna’s best interest at heart.
On their way back from their outing to an ice cream shop, where Lisa behaved in a rebellious way, nurse Valerie says to her, “Did you enjoy the fresh air, Lisa?” When Lisa responds with “yes,” Valerie says, while grinning, “Good, ‘cause it’s the last time you’re leaving the ward.”
Because Valerie is angry, she uses inappropriate language.
Good Will Hunting
Will Hunting, a working-class young math genius, is wasting his talent. Mathematics professor Lambeau takes him under his wings and finds a therapist for his protégé. In his therapy with Sean McGuire he begins the healing process of his childhood trauma.
Before meeting Sean McGuire, Lambeau introduces Will to three different therapists. One of them is a well-known author. In their first and only session, Will makes fun of the therapist by pretending to cooperate with fake revelations. When the therapist starts showing the first signs of insecurity, Will asks, “Do you find it hard to hide the fact that you are gay?” The therapist denies it, and Will says, “Two seconds ago you were ready to give me a jump.” After this provocation, the therapist storms out of his office and tells Lambeau, while Will can hear everything through the open office door, “I can’t do this pro bono work any more, it’s not worth it. … I am going on national television next week, I don’t have time to tell you what happened, much less talk to that raving looney in there, that absolute lunatic he is.”
The language the therapist used can potentially affirm his client’s deep self-doubts, even though Will appeared triumphant on a superficial level.
During Sean McGuire and Will Hunting’s first meeting, when Will lights a cigarette to provoke his therapist, McGuire says, “You know you would be probably better off shoving that cigarette up your ass. That would be healthier for you.”
Toward the end of their first session, McGuire fends off a series of verbal attacks during which Will insults the therapist’s painting. The dark image of an empty boat that floats on the waves of a stormy ocean represents McGuire’s loss of and grief for his deceased wife. For quite a while, Will doesn’t seem to be successful in his attempts to hurt his therapist. Eventually Will says, “Maybe you married the wrong woman,” and McGuire stops responding. Now his client knows that he hit a vulnerable spot in the therapist, repeats this statement, and asks, “What happened? Did she leave you? Was she banging another guy?” At this point McGuire grabs him by the throat angrily, pushes him against the wall, and threatens him, “If you ever disrespect my wife again, I will end you, I will fucking end you! Got that chief?” With this physical attack, the therapist gains control for the first time. But Will still tries to regain the upper hand as he responds with “time’s up” and leaves the office.
Using his client’s “language” and by responding on a physical level, McGuire demonstrates that he is the “alpha animal” in this relationship. Even though this involuntary, reactive physical attack might have been one of the very few ways to gain control over the session in order to eventually achieve a positive treatment outcome with this extremely resistant client, it is not an ethical intervention.
Toward the end of the second session the therapist says, “I can’t learn anything from you that I can’t learn in some fucking book, unless you want to talk about you. And I am fascinated. I’m in.”
This intervention which includes self-disclosure about the therapist’s feelings about his client, seems to be crucial for Will to start trusting McGuire and for the therapeutic process to begin. If a therapist speaks his client’s language to create an alliance with a blue collar client, this boundary crossing is appropriate.
During their entire third session neither the therapist nor the client says anything. Sometimes McGuire whistles softly. At the end of their third meeting he asks his client not to smoke. In contrast to their prior sessions, Will complies now. Afterward, McGuire talks about their silence to professor Lambeau. He explains that his client might need to prove to him that he doesn’t need to talk if he doesn’t want to, and that it is not therapeutically appropriate for McGuire to start talking first.
At the beginning of their fourth session, both the client and the therapist are silent again. Eventually McGuire nods off. This provokes Will to start talking by telling a joke, which opens a door for the therapist to direct him toward subjects that are close to his heart.
Dealing with silence is a complex issue and obviously there is no one way to handle it. McGuire’s approach, attitude, and intervention seem very effective with this highly resistive client.
In another session, Will states how he wants to make his new romance perfect by keeping his distance. In order to model vulnerability and convey that imperfections are desired aspects of an intimate relationship, McGuire says, “My wife used to fart when she was nervous. She had all sorts of wonderful idiosyncrasies. She used to fart in her sleep. One night it was so loud, it woke the dog up. She woke up and asked, ‘Is that you?’ I didn’t have the heart to tell her. … Yeah Will, she’s been dead for two years, and that’s the shit I remember. … Those are the things I miss the most, wonderful things, the little idiosyncrasies that only I know about. That’s what made her my wife.” As both laugh, Will loosens up and gains trust.
The language McGuire uses appears to be designed to build and support the therapeutic alliance, to demonstrate emotional risk-taking in romantic relationships, and to teach how this supports intimacy.
After Will says, “You fucking talk more than any shrink that I have seen in my life,” McGuire responds “I teach this shit, I didn’t say I know how to do it.”
The therapist sometimes ends the session by telling Will to “get the fuck out of here” and “fuck them,” directed toward his clients abusers.
McGuire speaks his client’s language to create an alliance with the blue collar client. This seems to be highly effective with this resistive client.
Toward the end of their work, McGuire addresses his client several times as “son.”
This is a re-parenting intervention for the fatherless Will. Again, it is clear that it was a highly effective intervention with this resistive client.
Gross Pointe Blank
A psychiatrist, Dr. Oatman, is alarmed to learn that his patient, Martin, is a hit man.
In response to the client informing the therapist that he knows where the therapist lives, the psychiatrist says: “Oh, that wasn’t a nice thing to say. That wasn’t designed to make me feel good.”
Oatman is obviously very concerned about his own welfare and expresses it in clear and appropriate terms. Ignoring the fact that a hit man informs his therapist that he knows where the therapist lives will be clinically inappropriate.
Toward the end of one session, Dr. Oatman says, “I’m not your doctor, Martin. I am emotionally involved with you. I’m afraid of you and that constitutes emotional involvement; it would be unethical for me to work with you under these circumstances.” As the psychiatrist gets more upset, he says that he feels compelled to be creative in a very interesting way, or else Martin will blow his brains out.
Therapeutic objectivity and efficiency suffers when the therapist is intimidated. This disclosure and the language used don’t seem to have any therapeutic purpose.
K-Pax
Dr. Mark Powell is intrigued by his new patient, Prot, who claims to be an alien from the planet K-PAX. In order to evaluate his knowledge in astronomy, the psychiatrist takes his patient to his astronomer friend, Steve Becker, and a group of astrophysicists. Later he brings Prot to a garden party with his wife Rachel, his children, and friends. Powell’s superior, Claudia Villars, does not agree with his approach.
A nurse brings Prot to Dr. Powell’s office, saying, “This one is as gentle as a pussycat, doc.”
The nurse’s disrespectful language is a boundary violation.
When Powell criticizes Prot because he makes other patients think that he can cure them, Prot responds, “For your information, all beings have the capacity to cure themselves, Mark.” The psychiatrist responds angrily, “Listen, on this planet I am a doctor, you are a patient.” Prot interrupts, saying, “Doctor, patient, curious human distinction.” This dialog continues with Prot asking why Mark hasn’t cured his patients yet, if he believes that this is his job.
When Powell suggests hypnosis, Prot tells him that he doesn’t see the point. The psychiatrist says angrily, “Let me tell you what your alternative is: “A trip to a place where they stick a needle in your ass every morning, which may or may not leave you with a stupid grin on your face for the rest of your days here on earth. Is that what you’d like?” Prot agrees to the hypnosis.
Because Powell is angry, he uses inappropriate language.
Mr. Jones
Mr. Jones gets treated for Bipolar Disorder in a mental hospital by Dr. Libby Bowen. They fall in love with each other and start a romantic relationship.
In one of their therapy sessions, Bowen loses her temper with Jones and, at the top of her lungs, tells him to shut up.
Because Bowen is angry, she uses inappropriate language.
Ordinary People
Conrad is the second son of a mild-mannered, successful attorney, Calvin, and a selfish, controlling mother, Beth. He sees psychologist, Dr. Berger, after a suicide attempt. Conrad blames himself for his older brother’s drowning death which resulted from a boating accident.
After Conrad states that his purpose for coming to therapy is to gain control over his life, Berger responds, “I’m not big on control.” In order to buffer the impact of this challenging statement, he continues, “But it’s your money, so to speak.” Then the psychologist uses teenage language like “Control is a tough nut.” With this comment, he prepares his client for his plan to have Conrad cancel his swimming practice and see him twice a week because they are working on a difficult problem.
Therapeutic language is avoided in order to make Conrad feel comfortable, building a therapeutic alliance. The mildly sarcastic tone in Berger’s language (“control is a tough nut”) might help nudge the teenager toward a different focus of therapy, such as grief, guilt, family issues, etc.
Prime
Rafi Gardet dates a younger man, David Bloomberg. After hearing about this relationship in their sessions for some time, her therapist, Dr. Lisa Metzger, finds out that Rafi’s boyfriend is her own son.
When Rafi arrives at her session looking very happy because she has fallen in love, her therapist responds, “Let’s have it!”
After describing their sexual encounters in graphic detail, Rafi worries about the age difference between her and David. Metzger replies, “Don’t worry, you are not going to marry him next week. … He didn’t tattoo his name on you, did he? … You are both in your sexual prime.” At this point the therapist doesn’t know yet that the boyfriend is her son.
Using this casual and loose language the therapist mirrors her client’s detailed description of her sexual experiences. This might support the therapeutic alliance, enhance trust, and instill confidence in the client.
What About Bob?
After one therapy session, Bob Wiley follows his psychiatrist, Dr. Leo Marvin, to his lakeside summer home in order to further discuss his problems. There, Bob befriends Marvin’s son Sigmund, daughter Anna, and wife Fay.
The answering service puts Bob through to his therapist’s vacation location because he pretends that Marvin’s sister is calling. The psychiatrist responds, “Bob, the doctor-patient relationship is based on trust. If you pretend to be my sister, I can’t trust you any more. Please do not call me here again.”
Although Marvin tries to sets appropriate boundaries, he failed with this intrusive (and charming) client. It is hard to judge Marvin’s language, as he has been pushed to the edge of sanity by a relentless (and funny) client.